title: Comparison of pharmacological and electrical cardioversion in permanent atrial fibrillation after prosthetic cardiac valve replacement: a prospective randomized trial.
abstract: OBJECTIVE
  To compare the efficacy of electrical versus pharmacological cardioversion following prosthetic cardiac valve replacement in patients with permanent atrial fibrillation (AF).
  
  
  METHODS
  Patients with permanent AF who had undergone prosthetic cardiac valve replacement, who had a cardiothoracic ratio ≤ 0.5 and a left atrial diameter ≤ 50 mm for ≥ 6 months after surgery were randomly divided to receive either electrical or pharmacological cardioversion. Patients in the electrical cardioversion group were given direct-current synchronized electrical defibrillation under general anaesthesia. Patients in the pharmacological cardioversion group were given oral combination therapy with amiodarone, captopril and simvastatin for 3 months.
  
  
  RESULTS
  A total of 115 patients received either electrical cardioversion (n = 59) or pharmacological cardioversion (n = 56); reversion to sinus rhythm occurred in 98.3% and 26.8%, respectively. Recurrence rates were similar in the two groups (3.4% and 6.7% for electrical and pharmacological cardioversion, respectively). No deaths or severe complications were reported.
  
  
  CONCLUSIONS
  Electrical cardioversion has a favourable safety profile and appears to be a more effective method than pharmacological cardioversion for the treatment of permanent AF after cardiac valve replacement, once the heart has returned close to its normal size.
authors.affiliation: Department of Cardiac Surgery, Second Hospital of Lanzhou University, Lanzhou, China.
authors.forename: Wen Sheng
authors.initials: WS
authors.lastname: Chen
authors.forename: Bing Ren
authors.initials: BR
authors.lastname: Gao
authors.forename: Wen Qin
authors.initials: WQ
authors.lastname: Chen
authors.forename: Zhen Zhen
authors.initials: ZZ
authors.lastname: Li
authors.forename: Zhi Yi
authors.initials: ZY
authors.lastname: Xu
authors.forename: Yan Hua
authors.initials: YH
authors.lastname: Zhang
authors.forename: Kun
authors.initials: K
authors.lastname: Yang
authors.forename: Xin Qiang
authors.initials: XQ
authors.lastname: Guan
mesh_terms: D000328:Adult; D000638:Amiodarone / Q000627:therapeutic use*; D000768:Anesthesia, General; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D002216:Captopril / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004558:Electric Stimulation / Q000379:methods*; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000187:drug effects* / Q000503:physiopathology / Q000601:surgery; D011446:Prospective Studies; D019821:Simvastatin / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D002216:Captopril; D019821:Simvastatin; D000638:Amiodarone
keywords: Electrical cardioversion; permanent atrial fibrillation; pharmacological cardioversion; prosthetic cardiac valve replacement